In my career as an emergency physician, I seldom discussed costs with patients. That's because they weren't interested.
Customers appreciate a contractor who can devise a way to save money or a butcher who recommends a good but inexpensive roast. But I soon found that medical consumers didn't care if I thought an X-ray of an obvious bruise or a mild ankle sprain wasn't necessary. Those with insurance wanted it anyway because they were "covered," while the uninsured, highly unlikely to pay their ER bills, suspected I was subtly withholding care. My feeble cost-cutting efforts were met with resentment, not thanks.
The truth is that Americans enjoy their foolish fantasy that medical care is free and that we're entitled to an unlimited amount. But it's far from free. On the contrary, the way we consume and pay for medical care is so hideously expensive that we've put ourselves into a box.
Medicare and Medicaid costs are now the primary drivers of the national debt that hangs like a cloud over our financial future. Middle class incomes have languished over the past two decades because productivity gains have been siphoned off by skyrocketing health care costs.
Something big has to change. It doesn't matter how much we like the status quo. There aren't enough rich people to soak or enough grandchildren to saddle with debt to keep us going much longer. The only question is whether medical costs will be managed by bureaucrats or by patients with their doctors.
Most Americans, with our traditions of personal liberty and limited government authority, would choose the latter. So here's the big question: Can patients become competent managers of their own medical care?
Most on the Left say no. Government health planners see medical decisions as so complicated and emotional that laymen are better off leaving the hard choices, well...to them.
Although I think they're wrong, they have a point. All living Americans have become so accustomed to third-party payment that we have lost the habits of mind required for rational medical decision making. We're not comfortable requiring payment for the medical "entitlement." We don't think in terms of cost/benefit ratios and our tolerance of risk is near zero, no matter what the cost.
But if we were to replace the unsustainable Obamacare model with premium-supported Health Savings Accounts, we would personally control our non-catastrophic medical expenses. It could be done. In fact, it is already being done, but some changes need to be made.
The most obvious need is more transparency in medical costs. Today, few patients know or care about the actual price of the care they receive. Worse, many providers don't know either.
All vendors and service providers should establish a standard retail price for all services and all customers and publish the information publicly. That would be technically easy. The main reason it isn't done now is because most sellers of medical care would rather you didn't know how wildly variable their charges are.
Next, patients should have access to a vast data-base of user-friendly medical information. More importantly, patients and doctors should become comfortable with the doctor in the role of consumer adviser, helping patients decide which of the options available are of most value.
For example, your doctor might advise that for someone of your risk profile, colonoscopy every 10 years is sensible. You could have one every five years, but it would double your cost and discomfort while reducing your risk very little. You get the information, you make the call, you pay for it out of your account.
The transition to self-responsibility wouldn't be easy, but we might end up actually liking it. When you think about it, the management of chronic conditions like cardiovascular disease, diabetes and arthritis has already replaced acute episodic care as the way most of us experience medical care. This so-called palliative care is more individualized and more dependent on patient values and preferences.
Making our own decisions on such sensitive matters as how much to spend on end-of-life care or even how much to spend on medical care overall rather than on other things might not be so bad. It sure beats letting government decide.
East Valley resident Tom Patterson (firstname.lastname@example.org) is a retired physician and former state senator.